Spring, Eye Allergies and Keratoconus: Why Rubbing Your Eyes Is Never Harmless
Spring brings warmer weather, flowering plants—and, for many people, red, watery and intensely itchy eyes.
When your eyes itch, rubbing them can feel almost irresistible. It may provide a few seconds of relief, but repeated or forceful eye rubbing can damage the cornea, particularly in people who are already susceptible to keratoconus.
The message this spring is simple:
Treat the itch. Don’t rub your eyes.
What happens during an eye allergy?
Seasonal allergic conjunctivitis develops when the eyes react to allergens such as pollen, grass, dust or mould. The body releases inflammatory substances, including histamine, which may cause:
• Itching
• Redness
• Watering
• Swollen eyelids
• Burning or irritation
• Sensitivity to light
Itching is particularly associated with allergy. Unfortunately, it is also the symptom most likely to trigger repeated eye rubbing.
Rubbing does not remove the allergy. It can increase irritation, worsen inflammation and create a cycle in which the eyes itch, are rubbed and then become even more irritated.
How does eye rubbing relate to keratoconus?
The cornea is the clear, curved window at the front of the eye. In keratoconus, the corneal tissue progressively becomes thinner and weaker, allowing the cornea to steepen and develop an irregular, cone-like shape.
This change prevents light from focusing evenly and may cause:
• Increasing astigmatism or short-sightedness
• Frequent changes in spectacle prescription
• Blurred or distorted vision
• Ghost images or multiple outlines
• Halos and glare around lights
• Difficulty driving at night
• Reduced vision that cannot be fully corrected with spectacles
Keratoconus is influenced by several factors, including genetic susceptibility. Eye rubbing is not the only cause, and not everyone with allergies will develop keratoconus. However, research has found a consistent association between habitual eye rubbing and keratoconus. Repeated mechanical pressure may contribute to corneal weakening and can be associated with progression in susceptible eyes.
Children and teenagers require particular attention because keratoconus may progress more rapidly at a younger age. A child who frequently rubs their eyes, has persistent allergies or requires repeated changes to their spectacle prescription should undergo a comprehensive corneal assessment.
What should you do when your eyes itch?
Try to avoid rubbing or pressing on the eyes. Instead:
• Apply a clean, cold compress over the closed eyelids.
• Use preservative-free lubricating drops to rinse and soothe the ocular surface.
• Use and eye formulated Hypochlorous Acid Spray daily.
• Wash your face and hands after outdoor exposure.
• Shower and change clothing after spending time in high-pollen environments.
• Keep bedroom windows closed when pollen or dust levels are high.
• Avoid direct airflow from fans or air conditioners towards the eyes.
• Consult an optometrist or ophthalmologist about appropriate anti-allergy treatment.
Allergy treatment may include antihistamine or mast-cell-stabilising eye drops. The correct medication depends on the severity and type of inflammation. Steroid eye drops should only be used under professional supervision because inappropriate or prolonged use can cause complications.
Controlling the allergy is an important part of breaking the eye-rubbing cycle.
How is keratoconus diagnosed?
A routine vision test may identify increasing astigmatism, but early keratoconus can be difficult to detect from a spectacle prescription alone.
Corneal topography and tomography create detailed maps of the front and back surfaces of the cornea. These measurements allow us to identify subtle changes in corneal curvature, thickness and symmetry—sometimes before a patient has experienced a major reduction in vision.
When keratoconus is suspected, scans can be repeated over time to determine whether the condition is stable or progressing.
Modern treatment is individualised
There is no single treatment suitable for every person with keratoconus. Management depends on the patient’s age, corneal thickness, the position and severity of the cone, evidence of progression and the level of functional vision.
Treatment has three distinct objectives:
1. Control allergy and eliminate eye rubbing.
2. Stabilise the cornea if the disease is progressing.
3. Improve the quality of vision.
Spectacles and specialised contact lenses
Spectacles may provide useful vision during the early stages of keratoconus. As the cornea becomes more irregular, spectacles and ordinary soft contact lenses may no longer correct the distortion adequately. Specialised lenses create a more regular optical surface and can significantly improve functional vision.
Options include:
• Custom soft keratoconus lenses
• Rigid gas-permeable lenses
• Hybrid lenses
• Corneal and mini-scleral lenses
• Full scleral lenses
• Impression-based EyePrintPRO lenses for highly irregular or complex eyes
Scleral lenses vault over the cornea and rest on the white part of the eye. The fluid reservoir beneath the lens masks corneal irregularity and creates a smooth optical surface.
These lenses can substantially improve vision, but they do not strengthen the cornea or stop keratoconus from progressing. Corneal stability must therefore be assessed separately.
Customised UV corneal cross-linking
Corneal cross-linking uses riboflavin—vitamin B2—and controlled ultraviolet-A light to strengthen the collagen structure of the cornea. Its primary purpose is to slow or stop further progression of keratoconus. In conventional cross-linking, clinicians apply a standard ultraviolet treatment pattern to the cornea. Customised UV cross-linking, or customised UVXL, uses the patient’s individual corneal maps to plan the ultraviolet treatment pattern and energy distribution. Treatment can therefore be concentrated on the affected region rather than applying an identical pattern to every cornea. The purpose remains stabilisation. Some patients may also experience flattening or improved corneal regularity, but cross-linking should not be presented as a replacement for spectacles or contact lenses.
CAIRS: reshaping the cornea with donor tissue
CAIRS stands for Corneal Allogenic Intrastromal Ring Segments. These are precisely shaped segments of donor corneal tissue implanted into channels created within the patient’s cornea.
The segments are designed to support and regularise the corneal shape. In appropriately selected patients, CAIRS may reduce corneal steepness and irregular astigmatism and improve uncorrected or corrected vision. Unlike synthetic intracorneal ring segments, CAIRS are made from human corneal tissue. Because the tissue is biologic, it offers a different biocompatibility profile from synthetic implants. CAIRS does not automatically replace cross-linking. If the keratoconus is progressing, cross-linking may still be required to stabilise the underlying disease. The procedures may be planned together or in stages according to the individual cornea. Patients may also continue to require spectacles or specialised contact lenses after CAIRS.
Early diagnosis protects future vision
Keratoconus is most manageable when it is identified before advanced thinning, distortion or scarring has developed. Modern treatment can often stabilise the cornea and provide useful functional vision, but timing matters.
Arrange a corneal assessment if you or your child:
• Rubs the eyes frequently
• Has persistent or severe eye allergies
• Requires frequent prescription changes
• Develops increasing astigmatism
• Experiences ghosting, glare or declining night vision
• Has a family history of keratoconus
This spring, do not ignore persistently itchy eyes—and do not rub them.
Control the allergy, assess the cornea and treat keratoconus before avoidable progression occurs.
References
Keratoconus, allergy and eye rubbing
Sahebjada S, Al-Mahrouqi HH, Moshegov S, Panchatcharam SM, Chan E, Daniell M, Baird PN. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2021;259:2057–2067. [doi:10.1007/s00417-021-05081-8](https://pubmed.ncbi.nlm.nih.gov/33484296/)
Seth I, Bulloch G, Vine M, et al. The association between keratoconus and allergic eye diseases: a systematic review and meta-analysis. Clinical & Experimental Ophthalmology. 2023;51(4):O1–O16. [doi:10.1111/ceo.14215](https://pubmed.ncbi.nlm.nih.gov/36882200/)
Diagnosis and general management
Gomes JAP, Tan D, Rapuano CJ, et al. Global consensus on keratoconus and ectatic diseases. Cornea 2015;34(4):359–369. [doi:10.1097/ICO.0000000000000408](https://pubmed.ncbi.nlm.nih.gov/25738235/)
Rabinowitz YS. Keratoconus. Survey of Ophthalmology. 1998;42(4):297–319. [doi:10.1016/S0039-6257(97)00119-7](https://pubmed.ncbi.nlm.nih.gov/9493273/)
Specialised contact lenses
Rathi VM, Mandathara PS, Dumpati S. Contact lens in keratoconus. Indian Journal of Ophthalmology. 2013;61(8):410–415. [doi:10.4103/0301-4738.116066](https://pmc.ncbi.nlm.nih.gov/articles/PMC3775075/)
Romero-Jiménez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: a review. Contact Lens and Anterior Eye. 2010;33(4):157–166. [doi:10.1016/j.clae.2010.04.006](https://pubmed.ncbi.nlm.nih.gov/20537579/)
Corneal cross-linking and customised UVXL
Cassagne M, Pierné K, Galiacy SD, Asfaux-Marfaing MP, Fournié P, Malecaze F. Customized topography-guided corneal collagen cross-linking for keratoconus. Journal of Refractive Surgery. 2017;33(5):290–297. [doi:10.3928/1081597X-20170201-02](https://pubmed.ncbi.nlm.nih.gov/28486719/)
CAIRS
Jacob S, Patel SR, Agarwal A, Ramalingam A, Saijimol AI, Raj JM. Corneal allogenic intrastromal ring segments combined with corneal cross-linking for keratoconus. Journal of Refractive Surgery. 2018;34(5):296–303. [PubMed record](https://pubmed.ncbi.nlm.nih.gov/?term=Corneal+allogenic+intrastromal+ring+segments+combined+with+corneal+cross-linking)
Kirgiz A, et al. Clinical outcomes of femtosecond laser-assisted corneal allogenic intrastromal ring segments in the treatment of keratoconus. Clinical & Experimental Ophthalmology. 2024. [PubMed record](https://pubmed.ncbi.nlm.nih.gov/38938058/)
Levy I, Mukhija R, Nanavaty MA. Corneal allogenic intrastromal ring segments: a literature review. Journal of Clinical Medicine. 2025;14(4):1340. [doi:10.3390/jcm14041340](https://pmc.ncbi.nlm.nih.gov/articles/PMC11856834/)
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